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Lung Cancer
Lung cancer, a cancer that forms in tissues of the lung, usually in the cells lining air passages,1
has traditionally been classified into two major types: non-small cell lung cancer (NSCLC) and
small cell lung cancer (SCLC).1 About 85 percent of all lung cancers are identified as non-small
cell, and approximately 75 percent of these are metastatic, or advanced, at diagnosis.2 NSCLC
can be further categorized into distinct subsets that are classified by a number of factors,
including histology and the molecular makeup of the tumor.
FACTS AND FIGURES
• Worldwide in 2012, an estimated 1.8 million new cases of lung cancer
were expected to be diagnosed,3 accounting for approximately 13 percent
of total cancer diagnoses.4 In the United States, an estimated 222,500 new
cases of lung cancer are expected to be diagnosed in 2017, accounting for
approximately 25 percent of total cancer diagnoses5
• Lung cancer is the leading cause of cancer death worldwide6 with an
estimated 1.6 million deaths each year.3 An estimated 155,870 deaths
from lung cancer are expected to occur in the U.S. in 2017, accounting for
about 25 percent of all cancer deaths.5
• Globally, lung cancer is the most common cause of cancer-related
deaths in men and the second most common in women. 3 More
people die of lung cancer in the U.S. than of colon, breast and prostate
cancers combined.5
222,500
NEW CASES OF
LUNG CANCER
• Since 1987, more women in the U.S. have died each year from lung cancer
than from breast cancer.5
RISK FACTORS
• Lung cancer affects a diverse group of people, including the young and non-smokers.
• Some lung cancer risk factors include:
—— Smoking cigarettes or cigars
—— Exposure to second-hand smoke, asbestos, radon, chromium, arsenic, soot or tar
—— Treatment with radiation therapy to the breast or chest
—— Personal or family history of the disease
• Historically, smoking was seen as the major risk factor in developing lung cancer. While
smoking is a significant factor, about 10 to 15 percent of lung cancers in the U.S. are
unrelated to smoking.7
• Most lung cancers do not cause any symptoms until the disease has already reached
an advanced stage. Even when symptoms do appear, they are often mistaken for
other health problems.
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May 2017
NON-SMALL CELL LUNG CANCER
• NSCLC is a disease in which malignant cells form in the tissues of the lung. NSCLC is a difficult disease
to treat, particularly in the metastatic or advanced setting (Stage IIIB/IV). In these patients, the five-year
survival rate is only 5 percent.5
• Previously thought of as one disease, doctors now understand that there are different types
of lung cancer, which can be driven by different biomarker profiles. Biomarker testing, which is
usually determined by testing tumor samples, can help doctors diagnose patients more accurately
and guide their treatment decisions.
• The National Comprehensive Cancer Network (NCCN) Guidelines ® recommend (category 1)
that metastatic NSCLC that is determined by histology to be adenocarcinoma or not otherwise
specified (NOS) undergo biomarker testing for EGFR mutations and ALK gene rearrangements.*
Testing for ROS1 rearrangements (category 2A) is also recommended in the NCCN Guidelines. 8
• Broad molecular profiling systems, such as next-generation sequencing (NGS) can detect panels
of mutations and gene rearrangements if the NGS platforms have been designed and validated to
detect these genetic alterations.
• The NCCN Panel now recommends (category 2A) IHC testing for PD-L1 expression before first-
line treatment in patients with metastatic NSCLC with negative or unknown tests results for EGFR
mutations, ALK rearrangements and ROS1 rearrangements.9
• EGFR mutations occur in 10 to 20 percent of NSCLC tumors10 and as high as 60 percent in NSCLC
tumors in Asian populations.11
• Epidemiology studies suggest that approximately 3 to 5 percent of NSCLC tumors are ALK-positive.12
• Approximately 1 percent of lung tumors harbor ROS1 fusions. Like ALK fusions, ROS1 fusions are
more commonly found in light smokers (<10 pack years) and/or never-smokers. ROS1 fusions are
also associated with younger age and adenocarcinomas.13
TREATMENT
• Current treatment options for NSCLC include surgery, radiofrequency ablation, radiation therapy,
chemotherapy, biomarker-driven therapy and immunotherapy. In some cases, more than one kind of
treatment is used.7
• Targets currently being used or investigated in the treatment of NSCLC include the human epidermal
growth factor (HER) family of receptors, EGFR, ERCC1, KRAS, ALK, BRAF, PI3KA, IGF-1R, c-MET, ROS-1
and RET.13, 14, 15, 16, 17, 18, 19
* Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
REFERENCES
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National Cancer Institute at the National Institute of Health website. Lung Cancer. 2009. http://www.cancer.gov/cancertopics/types/lung. Accessed March 3, 2016.
Reade CA, Ganti AK. EGFR targeted therapy in non-small cell lung cancer: potential role of cetuximab. Biologics. 2009;3: 215–224.
World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012.
http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. (Select Lung from drop down menu). Accessed March 3, 2016.
World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012.
http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. (Select All Cancers from drop down menu). Accessed March 3, 2016.
American Cancer Society. Cancer Facts & Figures 2017. Atlanta: American Cancer Society; 2017. Available at: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed on May 15, 2017.
World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2008: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012.
http://globocan.iarc.fr/Pages/fact_sheets_population.aspx (select ‘World’ from the drop down menu under ‘Fact Sheets’). Accessed May 12, 2017.
American Cancer Society website. Detailed Guide: Lung Cancer (Non-Small Cell). http://www.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf. Accessed March 3, 2016
National Comprehensive Cancer Network website. NCCN Clinical Practice Guidelines in Oncology: Non-small cell lung cancer Version 6. 2017.
http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed May 15, 2017.
Gadgeel, SM, Stevenson, J, Langer, CJ et al. Pembrolizumab (pembro) plus chemotherpay as front-line therapy for advanced NSCLC: KEYNOTE-021 cohorts A-C. Proc Am Soc Clin Oncol. 2016; 34 (Abstr 9016.)
Pao W, Miller VA. Epidermal growth factor receptor mutations, small-molecule kinase inhibitors, and non-small-cell lung cancer: current knowledge and future directions. J Clin Onc. 2005;23:2556-2568.
Mok T, Thongprasert S, Yang C, et al. Gefitinib or Carboplatin–Paclitaxel in Pulmonary Adenocarcinoma. N Engl J Med, 2009;361:947-957.
Garber K. ALK, lung cancer, and personalized therapy: portent of the future? J Natl Cancer Inst. 2010;102:672-675.
Bergethon K, Shaw AT, Ou SH et al. ROS1 rearrangements define a unique molecular class of lung cancers. J Clin Onc. 2012;30(8):863-70
Janku F et al. Targeted therapy in non-small-cell lung cancer- is it becoming a reality? Nature Reviews Clinical Oncology. 2010;7:401-414.
Vilmar, A, Santoni-Rugiu, E, Sorensen J. ERCC1 and histopathology in advanced NSCLC patients randomized in a large multicenter phase III trial. Annals of Oncology. 2010;21:1817 – 824.
Eberhard, DA, Johnson, BE, Amler, L, et al. Mutations in the Epidermal Growth Factor Receptor and in KRAS Are Predictive and Prognostic Indicators in Patients With Non–Small-Cell Lung Cancer Treated With Chemotherapy Alone and in
Combination With Erlotinib. Journal of Clinical Oncology. 2005;23:5900 – 5909.
Marchetti A, Felicioni L, Malatesta S, et al. Clinical Features and Outcome of Patients With Non–Small-Cell Lung Cancer Harboring BRAF Mutations. Journal of Clinical Oncology. 2011;29:3574 – 3579.
Metastatic Non-Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances. Hematology & Oncology Journal Online. http://www.hematologyandoncology.net/index.php/archives/april-2012/metastatic-non-small-cell-lung-cancer-management-novel-targets-and-recent-clinical-advances/#. Accessed August 7, 2013.
Dziadziuszko R, Camidge D, Hirsch F. The Insulin-Like Growth Factor Pathway in Lung Cancer. Journal of Thoracic Oncology. 2008;3:815 – 818.
© 2017 Pfizer Inc.
All Rights Reserved
May 2017